Provider Demographics
NPI:1114507613
Name:MORALES SANTANA, CAROLINE N
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:N
Last Name:MORALES SANTANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:
Mailing Address - City:LAS MARIAS
Mailing Address - State:PR
Mailing Address - Zip Code:00670-0347
Mailing Address - Country:US
Mailing Address - Phone:787-519-1389
Mailing Address - Fax:
Practice Address - Street 1:AVENIDA MUNOZ RIVERA
Practice Address - Street 2:EDIFICIO 309 BO. PUENTE
Practice Address - City:CAMUY
Practice Address - State:PR
Practice Address - Zip Code:00627-0061
Practice Address - Country:US
Practice Address - Phone:787-915-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-09
Last Update Date:2021-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR004306235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR6235673OtherDRIVERS LICENSE